From the Guidelines
Ibuprofen, diclofenac, naproxen, celecoxib, ketorolac, and parecoxib are considered safe analgesics during breastfeeding, as they have negligible transfer into breast milk or have been used extensively during lactation without adverse effects on the infant 1.
Safe Analgesics During Breastfeeding
The following analgesics are considered safe for use during breastfeeding:
- Ibuprofen: has been used extensively for postpartum pain and during lactation, and is considered safe to use during breastfeeding 1
- Diclofenac: small amounts are detected in breast milk, but it has been used extensively during lactation and is considered safe to use during breastfeeding 1
- Naproxen: although it has a longer half-life than diclofenac, naproxen is widely used after caesarean section, and breastfeeding may continue as normal 1
- Celecoxib: the relative dose that infants are exposed to via milk is very low, and breastfeeding may continue 1
- Ketorolac and parecoxib: low levels are detected in breast milk without demonstrable adverse effects in the neonate, and are compatible with breastfeeding 1
Important Considerations
It is essential to note that while these analgesics are considered safe, mothers should still be cautious and monitor their infant for any signs of adverse effects, such as sedation or respiratory depression. Additionally, the use of opioids, such as codeine, should be avoided during breastfeeding due to the risk of infant sedation and respiratory depression 1.
Alternative Options
For moderate to severe pain, alternative options, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), should be considered before using opioids. If opioids are necessary, the lowest effective dose should be used for the shortest period of time, and the infant should be monitored closely for signs of adverse effects 1.
From the Research
Analgesics Safe During Breastfeeding
- Paracetamol (acetaminophen) is considered safe for use during breastfeeding 2, 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally considered safe for short-term use during breastfeeding, with ibuprofen being a preferred option for long-term treatment 2, 4, 3
- Aspirin (acetylsalicylic acid) is considered safe in single doses, but caution is advised for long-term use 2, 3, 5
- Codeine is probably compatible with breastfeeding, although long-term exposure has not been fully studied 2, 3, 5
- Morphine is considered safe for short-term use, but long-term treatment requires careful assessment of the risks and benefits 2
- Propoxyphene is considered safe for short-term use, but long-term exposure may pose a risk to the infant 2
General Guidelines
- The lowest effective maternal dose of an analgesic should be used to minimize infant exposure 2
- Breastfeeding can be avoided at times of peak drug concentration in milk to reduce infant exposure 2
- The benefits of breastfeeding should be weighed against the potential risks of analgesic use on an individual basis 2, 3